Provider Demographics
NPI:1023425774
Name:PUSZKIEWICZ, ADRIANA JULIA (LMP)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:JULIA
Last Name:PUSZKIEWICZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 S ANGELINE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1872
Mailing Address - Country:US
Mailing Address - Phone:360-561-4003
Mailing Address - Fax:
Practice Address - Street 1:5236 CALIFORNIA AVE SW
Practice Address - Street 2:STE D
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1244
Practice Address - Country:US
Practice Address - Phone:360-561-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60416501225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist